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1.
Am J Transplant ; 22(12): 2903-2911, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: covidwho-2052209

RESUMEN

Emerging data support the safety of transplantation of extra-pulmonary organs from donors with SARS-CoV-2-detection. Our center offered kidney transplantation (KT) from deceased donors (DD) with SARS-CoV-2 with and without COVID-19 as a cause of death (CoV + COD and CoV+) to consenting candidates. No pre-emptive antiviral therapies were given. We retrospectively compared outcomes to contemporaneous DDKTs with negative SARS-CoV-2 testing (CoVneg). From February 1, 2021 to January 31, 2022, there were 220 adult KTs, including 115 (52%) from 35 CoV+ and 33 CoV + COD donors. Compared to CoVneg and CoV+, CoV + COD were more often DCD (100% vs. 40% and 46%, p < .01) with longer cold ischemia times (25.2 h vs. 22.9 h and 22.2 h, p = .02). At median follow-up of 5.7 months, recipients of CoV+, CoV + COD and CoVneg kidneys had similar rates of delayed graft function (10.3%, 21.8% and 21.9%, p = .16), rejection (5.1%, 0% and 8.5%, p = .07), graft failure (1.7%, 0% and 0%, p = .35), mortality (0.9%, 0% and 3.7%; p = .29), and COVID-19 diagnoses (13.6%, 7.1%, and 15.2%, p = .33). Though follow-up was shorter, CoV + COD was associated with lower but acceptable eGFR on multivariable analysis. KT from DDs at various stages of SARS-CoV-2 infection appears safe and successful. Extended follow-up is required to assess the impact of CoV + COD donors on longer term graft function.


Asunto(s)
COVID-19 , Trasplante de Riñón , Obtención de Tejidos y Órganos , Adulto , Humanos , Trasplante de Riñón/efectos adversos , SARS-CoV-2 , Supervivencia de Injerto , Estudios Retrospectivos , COVID-19/epidemiología , Prueba de COVID-19 , Estudios de Seguimiento , Factores de Riesgo , Donantes de Tejidos , Funcionamiento Retardado del Injerto/etiología
2.
Am J Transplant ; 22(9): 2217-2227, 2022 09.
Artículo en Inglés | MEDLINE | ID: covidwho-1901570

RESUMEN

Coronavirus disease-19 has had a marked impact on the transplant population and processes of care for transplant centers and organ allocation. Several single-center studies have reported successful utilization of deceased donors with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests. Our aims were to characterize testing, organ utilization, and transplant outcomes with donor SARS-CoV-2 status in the United States. We used Scientific Registry of Transplant Recipients data from March 12, 2020 to August 31, 2021 including a custom file with SARS-CoV-2 testing data. There were 35 347 donor specimen SARS-CoV-2 tests, 77.5% upper respiratory samples, 94.6% polymerase chain reaction tests, and 1.2% SARS-CoV-2-positive tests. Donor age, gender, history of hypertension, and diabetes were similar by SARS-CoV-2 status, while positive SARS-CoV-2 donors were more likely African-American, Hispanic, and donors after cardiac death (p-values <.01). Recipient demographic characteristics were similar by donor SARS CoV-2 status. Adjusted donor kidney discard (odds ratio = 2.08, 95% confidence interval [CI] 1.66-2.61) was higher for SARS-CoV-2-positive donors while donor liver (odds ratio = 0.44, 95% CI 0.33-0.60) and heart recovery (odds ratio = 0.44, 95% CI 0.31-0.63) were significantly reduced. Overall post-transplant graft survival for kidney, liver, and heart recipients was comparable by donor SARS-CoV-2 status. Cumulatively, there has been significantly lower utilization of SARS-CoV-2 donors with no evidence of reduced recipient graft survival with variations in practice over time.


Asunto(s)
COVID-19 , Trasplante de Hígado , Trasplante de Órganos , Obtención de Tejidos y Órganos , COVID-19/epidemiología , Prueba de COVID-19 , Humanos , Donadores Vivos , SARS-CoV-2 , Donantes de Tejidos , Estados Unidos/epidemiología
3.
Am J Transplant ; 21(11): 3743-3749, 2021 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1307664

RESUMEN

Transplantation of solid organs from donors with active SARS-CoV-2 infection has been advised against due to the possibility of disease transmission to the recipient. However, with the exception of lungs, conclusive data for productive infection of transplantable organs do not exist. While such data are awaited, the organ shortage continues to claim thousands of lives each year. In this setting, we put forth a strategy to transplant otherwise healthy extrapulmonary organs from SARS-CoV-2-infected donors. We transplanted 10 kidneys from five deceased donors with new detection of SARS-CoV-2 RNA during donor evaluation in early 2021. Kidney donor profile index ranged from 3% to 56%. All organs had been turned down by multiple other centers. Without clear signs or symptoms, the veracity of timing of SARS-CoV-2 infection could not be confirmed. With 8-16 weeks of follow-up, outcomes for all 10 patients and allografts have been excellent. All have been free of signs or symptoms of donor-derived SARS-CoV-2 infection. Our findings raise important questions about the nature of SARS-CoV-2 RNA detection in potential organ donors and suggest underutilization of exceptionally good extrapulmonary organs with low risk for disease transmission.


Asunto(s)
COVID-19 , Trasplante de Riñón , SARS-CoV-2 , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Riñón , ARN Viral/genética
4.
Rep Pract Oncol Radiother ; 26(1): 159-161, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1236911

RESUMEN

Radiotherapy is being performed in many situations as a curative approach for head and neck cancer instead of surgery due to the current novel coronavirus disease (COVID-19) pandemic. A recent publication reported that even hypofractionation was being conducted in order to reduce the daily exposure of both patients and the medical staff involved in cancer therapies. As a result, dental teams may be requested more frequently than usual to fabricate intraoral stents (IOS). Given that IOS may be a potential source of COVID-19 contagion, the main purpose of the present correspondence is to offer a guide on how health professionals may be safely presented in the room, on the management of the IOS and also how to sanitize the stents.

5.
J Prosthodont ; 30(5): 412-419, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-960947

RESUMEN

PURPOSE: The purpose of the study was to assess participants' and presenters' perceptions of a live web-based lecture series in comparison to traditional in-person lectures. MATERIALS AND METHODS: A virtual lecture series was organized by the---from March 25th until June 3rd of 2020. Twenty-five postgraduate prosthodontics programs and 81 presenters participated. Two surveys were developed and distributed to the audience (N = 330) and the presenters (N = 81). Follow-up emails were sent one week, three weeks, and four weeks after the initial email survey to encourage its completion. The data were analyzed descriptively. One-way ANOVA (p = 0.05), followed by a post hoc test, were used to compare the response percentages among the different generations of presenters and participants. RESULTS: Fifty-two percent of participants, and 65% of presenters, completed the survey. More than 96% of participants and presenters were satisfied with the lecture series. Seventy-nine percent of audience members felt that the live web-based lectures were as effective as traditional classroom lectures, or more effective; 32% of presenters agreed. Millennial audience members had significantly (p = 0.0028) more negative responses than the other generations. CONCLUSION: Participants have more positive perceptions of web-based lectures than presenters.


Asunto(s)
COVID-19 , Pandemias , Humanos , Internet , SARS-CoV-2 , Encuestas y Cuestionarios
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